Anxiety disorders, benzodiazepine prescription, and incident dementia

Abstract

BackgroundPrescribing benzodiazepines to older patients is controversial. Anxiety disorders and benzodiazepines have been associated with dementia, but literature is inconsistent. It is unknown if anxiety treated with a benzodiazepine, compared to anxiety disorder alone is associated with dementia risk.MethodsA retrospective cohort study (n = 72,496) was conducted using electronic health data from 2014 to 2021. Entropy balancing controlled for bias by indication and other confounding factors. Participants: Eligible patients were ≥65 years old, had clinic encounters before and after index date and were free of dementia for 2 years prior to index date. Of the 72,496 eligible patients, 85.6% were White and 59.9% were female. Mean age was 74.1 (SD ± 7.1) years. Exposure: Anxiety disorder was a composite of generalized anxiety disorder, anxiety not otherwise specified, panic disorder, and social phobia. Sustained benzodiazepine use was defined as at least two separate prescription orders in any 6‐month period. Main outcome and measures: ICD‐9 or ICD‐10 dementia diagnoses.ResultsSix percent of eligible patients had an anxiety diagnosis and 3.6% received sustained benzodiazepine prescriptions. There were 6640 (9.2%) incident dementia events. After controlling for confounders, both sustained benzodiazepine use (HR 1.28, 95% CI: 1.11–1.47) and a diagnosis of anxiety (HR 1.19, 95% CI: 1.06–1.33) were associated with incident dementia in patients aged 65–75. Anxiety disorder with sustained benzodiazepine, compared to anxiety disorder alone, was not associated with incident dementia (HR 1.18, 95% CI: 0.92–1.51) after controlling for confounding. Results were not significant when limiting the sample to those ≥75 years of age.ConclusionsBenzodiazepines and anxiety disorders are associated with increased risk for dementia. In patients with anxiety disorders, benzodiazepines were not associated with additional dementia risk. Further research is warranted to determine if benzodiazepines are associated with a reduced or increased risk for dementia compared to other anxiolytic medications in patients with anxiety disorders.

Benzodiazepine Consumption, Functionality, Cognition, and Somnolence in Older Adults at a Tertiary Care Psychiatric Hospital in Mexico City

“…In our sample, a higher percentage of BZD users were women (76.5%), aligning with international studies indicating a range between 67.4% and 74% [ 25 ]. The non-BZD group demonstrated a slightly higher level of education (average 9.54 years) compared to the BZD group (average 8.86 years), consistent with findings that lower education levels are associated with higher BZD consumption rates, especially in Latin America [ 19 ].…”

Stiff Person Spectrum Disorders—An Update and Outlook on Clinical, Pathophysiological and Treatment Perspectives

“…While GABAergic drugs are an important pillar in the symptomatic treatment of SPSD motor symptoms and can be used for anxiety treatment, cognition may be impacted in some cases over time with long-term benzodiazepine intake, particularly if benzodiazepines with a short half-life are used [ 28 , 29 , 30 ]. Although, there are conflicting reports on the type of benzodiazepine (short vs. long-acting) used and the long-term impact on cognitive function.…”